Month: September 2009

As our congress members and US senators explain why a public option and real health care reform is bad, let's be clear, if they do not do it now, the changes we need certainly won't happen on the state level.

Firstly, the US does not have a health care "system" yet to reform. No safety net for the average family. We have a system of care, Medicare, for the elderly, and Medicaid, a state system for people with disabilities and partly for the extremely poor. To be frank, there is no "system" of care for most Americans. We Idahoans are left to fend for ourselves in a sea of sparsely regulated private insurance companies who can deny claims, refuse to insure us, drop our coverage if we get sick, or price us out at any time for virtually any reason.

Note that, in Idaho, insurance companies use "discretionary clauses" or catch-all exceptions in insurance contracts to obscure what conditions, procedures, medications or treatments they might not cover. These are very broad statements giving companies legal room to deny care or payment. Only recently has the Idaho Department of Insurance actually begun to regulate some of these. Director Deal should be encouraged in his efforts. He's got a long way to go.

But to create a system of health care we still desperately need national reform. Eliminating discretionary clauses only helps those who actually have insurance. Those with bare-bones, catastrophic policies or high-deductible coverage will likely never use their policies until crisis strikes and they realize their lifetime maximums and fine print limitations will bankrupt or send them to the County’s Indigent Program anyway. Remember, we as tax payers, pay for this crisis care, through increased taxes and higher hospital bills. Paying for a system of preventative care and real national care could eliminate this tax burden and hospital cost escalator for all of us.

Congressman Minnick says he won't vote for a public option unless it's got cost-containment measures. Let's be serious. If you understand health care, you know that ensuring that everyone has decent access to health care, including preventative care, is itself a cost containment measure. A public option would offer roughly 50 million Americans a chance to go to the doctor rather than the emergency room for care. It would prevent costly cancers and conditions like diabetes and other ailments from becoming expensive medical crises.

Forcing all Idahoans to buy private insurance is not adequate. Such an approach would only make insurance companies more powerful and break small businesses and uninsured families.

Both Minnick and Simpson talk of eliminating "defensive procedures." More effective would be eliminating procedure-based reimbursement entirely. Doctors should be paid a generous salary to provide care. They should never feel compelled to pay off expensive equipment with unnecessary tests and scans. Critically, a public option could be designed to help provide communities with state-of-the-art medical equipment to be shared by providers in a local area.

Electronic Health Records are an important part of cost containment. Together with fine changes in liability law (so doctors trust each other’s tests) having a patient’s history and medications at each doctor’s fingertips, will eliminating duplicative testing and examination. The Obama Administration actually included fifteen million in the stimulus package for Idaho providers to convert to EHR.

As a legislator who serves on three committees which could have been advancing a system of health for every single Idahoan, I promise you change will not happen as long as insurance industry lobbyists continue to run health care and these committees, convincing law makers to kill every bit of industry accountability or transparency proposed.

For the past year, I've asked Democrats and Republicans, rural and urban people around the state whether they trust government or insurance companies more. That's a tough question in libertarian, anti-government Idaho. But people simply don’t trust the insurance industry. Every person in Idaho, with few exceptions has a story of how private insurance has harmed them, a friend or family member. And what of the fifty million who are uninsured or have very poor or inadequate insurance? Health Care in the US could not be more expensive. We have the most expensive and ineffective "system" in the world. People are ready for some predictability in health care, not more promises to be broken by companies with infinite legal funds and a long line of attorneys just waiting to explain why that illness, essential procedure or medication "is just not covered."

Simpson, Minnick, Risch and Crapo, this matters. Idaho’s businesses, families and budgets are drowning in this private insurer quagmire. We state law makers can't fix health care for Idahoans. You have to. It's now or never and not a debate that's just begun.